| Part 1 Effect of two-year weight management intervention on theprognosis in patients with chronic congestive heart failureBackground: Weight management(WM) can improve the prognosis in patients with chronic congestive heart failure(CHF) via modulating diuretics dose and restricting salt and water by weight monitoring. Half- year and 1-year WM could increase the weight monitoring compliance and WM ability of patients with CHF, and improve their cardiac function, and then decrease the rehospitalizition and improve their disease-related quality of life, but the effect of 2-year WM is unknown.Objective: To explore the effect of WM on the prognosis in patients with C HF.Methods: The study was a 2- year randomized controlled trial. Patients who met the inclusion criteria were randomly assigned to WM group(N=71) and control group(N=71). The control group received the standard care by the nurses in cardiovascular department, while WM group received a 2-year WM programme with scheduled telephone visits,which emphasized self- monitoring weight and meathods to deal with sudden weight gain.Data included drug use, weight monitoring compliance, scores of Weight Management Scale(WMS), NYHA classification, Left Ventricular Ejection Fraction(LVEF), Left Ventricular Internal Diameter at end-diastole(LVIDd), scores of Minnesota Living with Heart Failure Questionnaire(MLHFQ), CHF-related rehospitalization and mortality were collected and compared at baseline as well as half- year, 1- year and 2- year later.Results: Patients remained 53 in WM group and 54 in control group respectively. Users of the angiotensin-converting-enzyme inhibitors or angiotensin receptor inhibitors(AC EI/ARB) in WM group were less than that in control group(P<0.05).Weight monitoring compliance: There were 37(69.81%), 33(62.26%), and 25(47.17%)patients with good weight monitoring compliance in WM group at half- year, 1-year, and 2- year respectively, all higher than which were 8(14.81%),5( 9.26%) and(9.26%)respectively in control group(P < 0.001); In WM group, patients’ weight monitoring compliance was lower at 2-year than that at half- year(P<0.013); In control group, there were no statistical difference of patients’ weight monitoring compliance at any two time points(P>0.013).Weight management ability: We observed higher scores of WMS in WM group than that in control group at half- year, 1-year and 2-year, included each dimension of the WMS(P<0.01); And the scoresat half- year, 1- year and 2-year in WM group were higher than that at baseline except the WM-belief demension(P<0.013); In the control, only scores of WM-practice demension at half- year and 1-year and the total score of WMS at 1-year were higher than that at baseline(P<0.013).Cardiac function: At half- year, 1-year and 2-year, Patients with NYHAⅡin WM group were all more than that in control group(P < 0.01);There were no statistical difference of LVEF and LVIDd between the 2 groups at any time, but LVIDd was smaller in WM group compared with control group(56.02±9.391 vs. 60.44±9.886 mm, P<0.05) after the Intention-to-treat analysis(ITT).Disease-related quality of life: The total score of MLHFQ at half- year, 1-year and 2-year in WM group was significantly lower compared with control group, as well as the physicalfield and the emotion field(P<0.01); In WM group, the scores of MLHFQ and all fields at half- year, 1- year and 2-year were lower compared with baseline(P<0.013); But in control group, the score of emotion field at 1-year was higher than that at baseline andhalf- year(P>0.013).CHF-related rehospitalization: Patients in WM group generated significantly less CHF-related rehospitalization than control group at 1-year and 2-year(0.64±0.834 vs. 1.15±1.379, and 1.11±1.325 vs. 1.94±2.398, P<0.05), while there was no statistical difference of CHF-related rehospitalization between WM group and control group at half- year(0.28±0.568 vs. 0.44±0.744, P>0.05).CHF-related mortality: There were 1 patient died of C HF in WM group and 4 in control group at 1-year, and 6 in WM group and 5 in control group at 2-year, which revealed both no difference between two groups.Conclusion: Two-year WM could increase weight monitoring compliance and WM ability of patients with CHF, then improve their cardiac function and disease-related quality of life, finally decrease CHF-related rehospitalization. Although it did not decrease CHF-related mortality, it reduced the users of ACEI/ARB,Part 2 Qualitative study on weight management implementation status and problems in patients with chronic congestive heart failureBackground: Weight management(WM) could improve the prognosis of chronic congestive heart failure(C HF), but its effect was getting worse as time went on. It can lay the evidence-based foundation of the further study by understanding patients’ firsthand experience.Objective: To comprehend the weight management implementation status and its problems in patients who had received WM program, in order to simplify the content of WM and optimize the intervention program of WM.Methods: Talk to 9 patients who had received WM program by semi-structured in-depth interview, focusing on the weight management implementation status and its problems.Seven-stage Colaizzi method was used for analyzing, extracting and concluding the data and then form the themes.Results: WM program performed well in patients with CHF, and there were 5 themes emerged: It could help me perceive my condition changes by sudden weight gain; I believe the benefit of WM sufficiently and develop the habit of weight monitoring; I can craftily master the use of diuretics; I can restraint the desire of drinking water; Kind reminding from family urged me to do it. There were 4 problems generated from the data: Insufficient belief suspended my behavior of weight monitoring; Adverse life events hindered the WM process; Cognitive mistakes and knowledge uprush; The content of WM was too much to distinguish.Conclusion: WM program performed well in patients with C HF, but there were some problems in the process. It need to be further simplified and optimized in the next stage. |
PDF Full Text Request